An Outcome Analysis of Intraoperative Angiography for Postmastectomy Breast Reconstruction

Duggal, Claire S.; Madni, Tarik D.; Losken, Albert

doi:10.1177/1090820x13514995

Cited by 133 publications

(121 citation statements)

References 17 publications

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“…1). After detailed examination of 30 full‐text articles, 18 studies7 19, 20 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, including 2077 patients, were included in this review.…”

Section: Resultsmentioning

confidence: 99%

“…One was to compare rates of mastectomy necrosis and other complications, such as reoperation rates, and clinical outcomes between the techniques used ( Table 1). Seven case series7 28, 29, 30, 31, 32 34 and one cohort study33 used this approach. The alternative approach in seven prospective cohort studies19 20, 35, 36, 37, 38, 39 was to evaluate flap perfusion using the intraoperative modalities and to record the predicted areas of necrosis using photographic documentation or video recording.…”

Section: Resultsmentioning

confidence: 99%

“…One retrospective case–control study40 and one case series41 were designed to define numerical parameters corresponding to perfusion when using intraoperative techniques. Two studies30 42 performed retrospective cost analysis for the use of ICGA (including a secondary cost analysis in a case series30). …”

Section: Resultsmentioning

confidence: 99%

“…Mastectomy flap necrosis rates were compared with clinical judgement in seven7 28, 29, 30, 31, 32, 33 studies using ICGA, one study using FA33 and one pilot study using ODIS34. Use of ICGA in 652 and FA in 34 breasts resulted in a decrease in mean mastectomy flap necrosis compared with clinical judgement in 1964 breasts (7·9 and 3 compared with 19·4 per cent) ( Table 3).…”

Section: Resultsmentioning

confidence: 99%

“…Use of ODIS in five patients resulted in a mastectomy flap necrosis rate of 20 per cent34. Studies varied in their classification of skin necrosis; some did not offer a definition, whereas others30 32, 35 used a scoring system such as mild, moderate or severe, with a description of what was meant by these terms.…”

Section: Resultsmentioning

confidence: 99%

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Systematic review of methodologies used to assess mastectomy flap viability

et al. 2018

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BackgroundAccurate prediction of mastectomy skin flap viability is vital as necrosis causes significant morbidity, potentially compromising results and delaying oncological management. Traditionally assessed by clinical judgement, a more objective evaluation can be provided using intraoperative imaging modalities. This systematic review aimed to compare all intraoperative techniques for assessment of mastectomy flap viability.MethodsA systematic literature review was performed using MEDLINE and Embase databases. Primary outcomes reported included specificity, sensitivity and predictive values of each test, and mean rates of mastectomy flap necrosis and reoperation. Secondary outcomes included cost analysis.ResultsSome 18 studies were included. Designs were prospective cohort study (8), retrospective case series (4), prospective case series (3), retrospective case–control study (1), prospective pilot trial (1) and cost analysis study (1). The studies compared indocyanine green angiography (ICGA) (16 studies) and fluorescein dye angiography (FA) (3 studies) with clinical judgement. Sensitivity and specificity were highest for ICGA (5 studies) ranging from 38 to 100 and 68 to 91 per cent respectively. Both methods overpredicted necrosis. Mean rates of flap necrosis and reoperation decreased with ICGA (7·9 and 5·5 per cent respectively) and FA (3 and 0 per cent) compared with clinical judgement (19·4 and 12·9 per cent). Two studies were designed to define numerical parameters corresponding to perfusion using intraoperative techniques. Two studies performed a cost analysis for ICGA; one claimed a cost benefit and the other advocated its use in high‐risk patients only.ConclusionICGA and FA are potentially useful tools for mastectomy flap assessment. However, the predictive accuracy is subject to the specific settings and model of equipment used. Current recommendations support their use in high‐risk patients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Systematic review of methodologies used to assess mastectomy flap viability

et al. 2018

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Use of Laser-Assisted Indocyanine Green Angiography for Early Division of the Forehead Flap Pedicle

Surowitz¹,

Most

2015

JAMA Facial Plast Surg

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The paramedian forehead flap is used to reconstruct medium to large nasal defects. The staged nature, with its vascular pedicle bridging the medial eyebrow to the nose, results in significant facial deformity. Earlier division lessens this morbidity. OBJECTIVES To quantify flap neovascularization 2 weeks after the initial flap transfer and to describe an algorithm for earlier division of the flap pedicle in select patient populations.

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Assessment of Fibula Flap Skin Perfusion in Patients Undergoing Oromandibular Reconstruction

Beckler

Ezzat

Seth

et al. 2015

JAMA Facial Plast Surg

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IMPORTANCE Complications of partial flap necrosis contribute substantially to morbidity in patients who undergo head and neck reconstructive surgery. OBJECTIVE To assess the usefulness of clinical findings, intraoperative fluorescein angiography, and intraoperative indocyanine green angiography (ICGA) for evaluation of flap skin paddle perfusion in patients undergoing oromandibular reconstruction who are at high risk of partial skin paddle necrosis. DESIGN, SETTING, AND PARTICIPANTS Retrospective medical record review from May 21, 1996, to May 27, 2015, at a tertiary care academic medical center. Participants were 73 patients who underwent reconstruction of through-and-through defects of the mucosa, mandible, and skin using fibula free flaps that contained large bilobed skin paddles. MAIN OUTCOMES AND MEASURESThe rates of partial skin paddle necrosis and revision reconstructive surgery. RESULTSThe rates of partial flap necrosis were 8% (n = 2) among 25 patients in whom the skin paddle was trimmed based on ICGA and 33% (n = 16) among 48 patients in whom the skin paddle was trimmed according to clinical findings (P = .02). The rates of revision reconstructive surgery were 20% (5 of 25) when flap skin paddles were trimmed using ICGA and 42% (20 of 48) when trimmed per clinical findings (P = .06). CONCLUSIONS AND RELEVANCEThe use of ICGA may reduce the risk of partial skin flap necrosis in free flaps used in patients undergoing head and neck reconstruction who are at high risk of developing flap necrosis. Indocyanine green angiography imaging should be considered in any flap in which skin paddle viability is uncertain based on clinical findings and in patients in whom the skin paddle extends beyond the primary and adjacent angiosomes. LEVEL OF EVIDENCE 3.

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An Outcome Analysis of Intraoperative Angiography for Postmastectomy Breast Reconstruction

Abstract: The use of ICG angiography during postmastectomy breast reconstruction decreased the incidence and severity of mastectomy skin necrosis as well as the incidence of unexpected reoperations for perfusion-related complications. The technology was found to be cost-effective.

Cited by 133 publications

References 17 publications

Systematic review of methodologies used to assess mastectomy flap viability

Systematic review of methodologies used to assess mastectomy flap viability

Use of Laser-Assisted Indocyanine Green Angiography for Early Division of the Forehead Flap Pedicle

Assessment of Fibula Flap Skin Perfusion in Patients Undergoing Oromandibular Reconstruction

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